[Sense of smell, physiological ageing and neurodegenerative diseases: II. Ageing and neurodegenerative diseases]

INTRODUCTION

The sense of smell, which was once studied because of its biological and evolutionary significance, is today one of the centres of interest in research on normal and pathological ageing. The latest scientific developments point to an inversely proportional relationship between age and olfactory sensitivity. In certain neurodegenerative diseases this sensory decline is one of the first symptoms of the disorder and is correlated with the progression of the disease.

DEVELOPMENT

In this work we are going to review the scientific knowledge on loss of sense of smell in ageing and in neurodegenerative diseases, with special attention given to Alzheimer's and Parkinson's diseases.

CONCLUSIONS

A survey of studies that have examined the olfactory deficits in ageing and in some neurodegenerative diseases offers conclusive results about the presence of these impairments in the early stages of these disorders and even among healthy elderly persons. Although a number of causes contribute to these sensory losses in physiological ageing, a common neurological foundation has been proposed for Alzheimer's and Parkinson's diseases. Nevertheless, despite certain initial similarities, the olfactory deficits shown in these disorders seem to be qualitatively different.

[Sense of smell, physiological ageing and neurodegenerative diseases: I. Anatomy and clinical examination]

INTRODUCTION

Different studies on normal and pathological ageing have shown structural and functional impairment by means of psychophysical measures, electrophysiological studies and brain imaging studies. Lower sensory perception from peripheral olfactory structures, together with alterations in the medulla oblongata and cortex, are the most frequent causes of olfactory impairment in ageing.

AIM

To outline the most important tests that can be applied in clinical evaluation.

DEVELOPMENT

The article begins by reviewing concepts involved in olfactory anatomy and physiology and then goes on to describe the different methods of examination and their applicability to medical diagnosis.

CONCLUSIONS

Incorporating olfactory tests into clinical practice makes it possible to study the presence of sensory and cognitive impairment in greater depth, especially in ageing and in neurodegenerative diseases; this will allow a possible diagnosis to be expanded and completed.

[Emotional processing of facial expressions in normal and pathological ageing]

INTRODUCTION

Many studies have shown that in both normal and pathological ageing there is a deterioration of emotional processing, especially as regards negative emotions such as fear.

AIM

To review the most important neurological and psychological research carried out to study emotional processing and relate it to the cognitive deterioration that characterises normal ageing and neurodegenerative diseases.

DEVELOPMENT

Here, we discuss the two main lines of research, i.e. the socio emotional approach, which claims that as we get older we gain a better understanding of our emotions because of a deeper knowledge of social relationships, interpersonal enrichment and the importance of goals that are linked to our emotional life; and, on the other hand, the neuropsychological approach, which studies the areas of brain activation involved in processing emotional facial expressions and the underlying mental processes.

CONCLUSIONS

Both approaches underline the deficient processing of negative emotions that comes with age, while processing of positive emotions remains relatively intact. Recent research suggests that deficits in emotional processing depend on the cognitive deterioration that characterises ageing. When the task requires resources from working memory, which is one of the first systems to deteriorate in ageing, the result is compromised emotional processing. Yet, when the task requires the use of implicit memory, no age-related alterations are observed in emotional processing.

Use of Silybum marianum fruit extract in broiler chicken nutrition: influence on performance and meat quality

The present study aimed at evaluating the effects of different doses of silymarin in diet on broiler performances and meat quality. For the trial, 180 male chicks (ROSS 508), were allocated in to three groups (S0, S40 and S80) of 60 animals each receiving a basal diet supplemented with 0 ppm, 40 ppm and 80 ppm of a sylimarin (provided by a dry extract of Silybum marianum fruits) respectively. During the trial feed consumption and live body weight were taken every 20 days. At the age of 40 and 60 days blood samples were taken in order to evaluate protein, aspartate aminotransferase, cholesterol, tryglicerides and uric acid. At the age of 60 days animals were slaughtered, dressing percentages were evaluated and samples of breast and meat were taken to evaluate chemical composition and susceptibility of lipid peroxidation by means of thiobarbituric acid reactive substances. Silymarin at the tested doses did not affect growth performances but slightly affected slaughtering yields negatively, no specific hepatoprotective effect was found. Treatments reduced lipid content of both breast and thigh and increased muscles resistance to oxidative stress.

Pancreatic autoantibodies in Italian patients with newly diagnosed type 1 diabetes mellitus over the age of 20 years

The aim was to estimate the prevalence of the serological markers of pancreatic autoimmunity in a cohort of Italian patients with type 1 diabetes mellitus occurring after 20 years of age in order to determine the prevalence of autoimmune diabetes and the most sensitive autoantibody combination to be employed for the diagnosis. We investigated 57 patients (31 males and 26 females) at clinical diagnosis of type 1 diabetes. 35 patients were 21-40 years and 22 were 41-72 years of age. Autoantibodies to islet-cells (ICA) were detected by indirect immunofluorescence, while those against glutamic acid decarboxylase (GADA), tyrosine-phosphatase (IA2A) and insulin (IAA) were detected by radiobinding assays. A positive test for at least one of the pancreatic autoantibodies was found in 45 of the 57 patients (78.9%). Coupling two antibody tests, GADA and/or IAA were found in 73.7%, ICA and/or GADA in 71.9%, while GADA and/or IA2A were found in 70.2% of the patients. The most frequently positive test was for GADA (66.7%). In general, the frequency of diabetes-related antibodies was higher in the 21-40-year-old group compared to the 41-72-year-old group and in females than males. Based on the detection of pancreatic autoantibodies determination, the great majority of the adult patients with recent onset type 1 diabetes were found to be autoimmune in nature. The best cost/benefit combination is provided by coupling the detection of GADA and ICA.

The autologous serum skin test in the follow-up of patients with chronic urticaria

BACKGROUND

The presence of anti-FcepsilonRI and anti-IgE autoantibodies in a subset of patients with chronic urticaria suggests their aetiopathogenetic role. In clinical practice, the presence of these antibodies is usually considered when the autologous serum skin test (ASST) is positive.

AIMS

To evaluate if the positive ASST follows up the activity of chronic urticaria.

METHODS

Autologous serum skin test and thyroid autoantibody detection were performed in 82 patients with chronic urticaria and repeated 1 year later, when the vast majority of patients were symptom-free. Twenty patients with Hashimoto thyroiditis (HT), who had never suffered from urticaria, represented the control group.

RESULTS

At the start of the study, the prevalence of positive ASST was 46.6%. The association of HT-urticaria was 29.3%. ASST was positive in 62 and 39% of patients with and without HT, respectively (P > 0.05 ns). One year later, 28 of 34 patients with a positive ASST were symptom-free, but 50% of them were positive for ASST. The ASST was positive in 86.7 and 8% of patients with and without HT, respectively (P < 0.001). In the control group, ASST was always negative.

CONCLUSIONS

The co-existence of autoimmune thyroiditis with chronic urticaria seems to induce a significant difference in the persistence of a positive ASST. Consistent with previous reports, a positive ASST correlates with disease exacerbation in chronic urticaria patients without thyroiditis. In patients with thyroiditis and urticaria, positive ASST persists even after the urticaria has disappeared, thus questioning whether a positive ASST to be a surrogate marker of the functional role of anti-FcepsilonRI and anti-IgE autoantibodies.

Pancreatic autoantibodies in Italian patients with newly diagnosed type 1 diabetes mellitus under the age of 20 years

We analyzed 97 children and young persons (< 20 years of age) with newly diagnosed diabetes for antibodies to islet cells (ICAs), glutamic acid decarboxylase (GADAbs), second-islet antigen (IA2Abs), and insulin (IAAs) in order to evaluate the prevalence of immune-mediated type 1 diabetes, as well as to recognize which autoantibody combination is better associated with the disease. A positive result for one or more diabetes-related antibodies evaluated was found in 92 children (94.8%): 41 females (95.3%) and 51 males (94.4%). With regard to single autoantibody testing, ICA levels were found to be positive in 84 patients (86.6%), GADAbs in 71 (73.2%), IA2Abs in 60 (61.8%), and IAAs in 51 (52.6%) patients. Combining the determination of at least two autoantibodies, ICAs and/or GADAbs were more frequently detectable than other antibody combinations, being positive in 89 patients (91.8%). Our data indicate that the vast majority of cases of type 1 diabetes in children may be considered as immune-mediated, that multiple autoantibody analysis improves identification of the disease, and that first-level screening is provided by the combined detection of ICAs and GADAbs.

Special care units for demented patients: a multicenter study

The local government of Regione Lombardia, Italy, recently (1994) funded a clinical and research project specifically devoted to dementia (Piano Alzheimer). A central role in this project has been reserved for the special care units (SCUs) for demented patients with behavioral disturbances. In order to evaluate their effectiveness, eight SCUs took part in this study. A specifically designed care program, focusing on environment and staff, was implemented in each SCU. Cognitive, functional, and somatic health status, and use of psychotropic drugs and of physical restraints were assessed at baseline, and after 3 and 6 months in 55 consecutively admitted patients. The data show an overall reduction in behavioral disturbances and a decreased use of psychotropic drugs and physical restraints.

[Suppression of the opiate withdrawal syndrome with GABA analogs, low-dose psychotropic drugs and acupuncture]

15 male heroin addicts, 19-26 yr, were given 20 hospital treatments for detoxifying. Therapeutic program was based on GABAergic drugs (1-glutamine, sodium valproate, pyridoxine), low doses psychodrugs and acupuncture, added from the 3rd day. A full avoidance of the withdrawal syndrome was reached in 15 out of 18 Ss so treated with 8-10 hours following the last heroin injection, while the remaining 3 Ss experienced only a slight form of syndrome, which completely disappeared within the 24th hour. The 2 Ss manifesting evident symptoms of withdrawal and starting the therapeutic program respectively at the 20th and 32nd hour had their syndrome stopped and suppressed respectively within the 24th and 48th hour. Acupuncture accelerated the somatopsychic recovery leading to a lowering of the daily doses of the drugs used.

[Acupuncture as a part of a program of detoxification and weaning from opiates: 25 cases]

Presents results of a detoxification and habit loosing program carried out in 25 morphine-like substances addicts (mainly heroine) aged 19-26. The therapeutic treatment based on gabaergic drugs (l-glutamine, sodium valproate and piridoxine), low doses psychodrugs (tricyclics and benzodiacepines) and acupuncture, began in 13 subjects at the hospital and continued at the outpatients' service, while 12 subjects were treated only at the outpatients' service. Follow up: 6 subjects of the hospitalized group free from the addiction (5 subjects from more than 1 year after their discharge); 3 subjects of the outpatients' group abstinent from no more than 4 months after discharge. Biochemical mechanisms involved in this therapeutic program are extensively discussed.

[Experience with detoxification and weaning of heroin addicts by means of acupuncture, gabergic drugs and psychopharmacologic agents in low doses]

Presents extensive reports of detoxification and habit loosing trials in 9 male heroine addicts, 19-26 yr. The therapeutic programs were centered on gabergic drugs, low doses tricyclic antidepressants and benzodiazepines, and acupuncture (main points: 8 GB; nasal GB; 1 GB; 3 L; 4 LI; 36 S; 7 H; auricular Shen men) and were continued weekly at the Mental Health Outpatients Service, after discharge from the hospital.

RESULTS

2 Ss, personally checked, abstinent 6 months after their discharge; 4 Ss heard as abstinent and 3 Ss relapsed. Technique, course and times of the therapeutic program seem to be one of the key factors for success.

[Acupuncture, "vital" drugs and psychotropic agents in psychiatric patients. 50 cases]

A therapeutical trial by means of acupuncture and "vital" drugs (1-glutamine and N-dipropylacetic acid) in 23 out of 50 psychiatric chronic patients basically depressive, and by means of acupuncture, vital drugs and psychodrugs in the remaining 27 similar patients, is carefully reported. 49 of this patients got improvement, 41 of them in a middle degree. The different neurochemical curcuits (GABA-ergic, glutamergic, adrenergic, noradrenergic, serotoninergic and dopaminergic) put in balance by such therapeutical association have been discussed.

[Acupunctura, "vital" drugs and psychopharmacological agents in the treatment of psychiatric patients with deep depressive disorders, with considerations on the probable neurophysiological mechanisms of the synergism of action]

Personal clinical experience in 36 psychiatric patients with true or masqued depression, receiving a combined treatment of acupuncture (in traditional and auricolar suprarenalic points), "vital" drugs (DPA 300-900 mg/die; l-glutamine 250-500 mg/die) and psycho-drugs (amitryptiline 50 mg/die; clomipramine 10-30 mg/die; diazepam 2-20 mg/die; haloperidol 2 mg/die) is described. 35 out of 36 cases improved by such therapy. Possible synergic mechanisms leading to a considerable reduction of usual phychodrugs, and attenuating or eliminating various side effects are finally discussed.

[Acupuncture and psychiatry. Preliminary note]

Personal experience with acupuncture as a therapeutic technique in psychiatry is presented. Its effects on the patient and the taking of drugs are discussed. The results, like those reported by Chinese and other Italian workers, were encouraging and indicate that the technique may be more widely adopted in this field.